||The radiology department of LDS Hospital provides excellent care through the latest advances in technology and equipment, and licensed specialists. Although the services provided in the radiology department are outstanding. Quality improvement activities are lacking due to clinical information management problems. For example, neither hand written nor electronic records regarding discordant cases are permanently stored. The lack of permanent records leads to difficulties in JCAHO reporting, measuring problems, and providing performance feedback. The purpose of the project was to perform a systems analysis in order to develop an automated process for delivering performance feedback to radiologists as well as developing graphic output feedback displays. Performing a systems analysis before implementation of the automated process was necessary in order to study the existing feedback process through current process models before recommending a solution. The system analysis was performed in the radiology department utilizing a methodology called FAST, which consists of eight overlapping phases. Only the first three phases, the survey, study, and definition phases, were employed during the course of the project. Further data collection methods of the project included observing radiologists during their normal workflow, interviewing radiologist and other professionals within the department, and developing and distributing a questionnaire to radiologists. Based on finding from data collected and analyzed, the peer review process should be automated to permanently capture peer review data. Although all prior images and reports are peer reviewed when a patient returns for an examination, the automated feedback process should only capture peer review data from specialists. Thus, specialists will over-read reports from "on call" radiologists initially read during the "emergency" hours of 10 p.m. and 7 a.m., depending upon the modality of the report. Feedback regarding discordant cases will be provided to radiologists automatically and privately through the Radiologist Workstation from peer review data captured in a QA database. Radiologist should be enabled to review a time-series graph, showing performance over time, a tally plot graph, showing rates of discordant cases, and a comparison chart, comparing their own performance to the radiology department as a whole. Addendums, in the form of text, will also be available. The Chair of Radiology will be provided access to performance data of all radiologists. The determination for types of display graphs was based on review of the literature, as will through data collection from the participants.